Implementation of an Oncofertility Program: Key Elements, Challenges, and Solutions of the Oncofertility Treadmill

Main Article Content

Anisa Hussain, MA Jacqueline Sehring, MA Safina Usmani, MA Lauren Grimm, MA Ahmad Abadi, MD Angeline Beltsos, MD Roohi Jeelani, MD


An overwhelming proportion of females of reproductive age are affected by cancer annually. As the efficacy of cancer treatments increases the number of cancer survivors, it is imperative to ensure that the fertility-related needs of cancer survivors are met. Given the gonadotoxic nature of many cancer treatments, fertility preservation for patients prior to cancer treatment, Oncofertility, is a critical area of reproductive care. The establishment of an Oncofertility program requires swift and effective patient care that relies heavily on collaboration between multiple specialties, patient education, and clear treatment protocol. This specific flow of patient care can be referred to as an “Oncofertility treadmill,” given the emphasis on efficiently completing ovarian hyperstimulation cycles so that the patient may proceed with cancer treatment. We began by identifying key steps in the establishment of an Oncofertility program at a private, multisite fertility clinic, then explored the challenges that providers and patients may face, and the outcomes of Oncofertility patients undergoing ovarian hyperstimulation with the intention of oocyte cryopreservation. Oncofertility care is complex and the establishment of concrete guidelines for this Oncofertility care will greatly benefit cancer survivors.

Article Details

How to Cite
HUSSAIN, Anisa et al. Implementation of an Oncofertility Program: Key Elements, Challenges, and Solutions of the Oncofertility Treadmill. Medical Research Archives, [S.l.], v. 9, n. 9, sep. 2021. ISSN 2375-1924. Available at: <>. Date accessed: 25 oct. 2021. doi:
Research Articles


1. American Cancer Society. Cancer Facts & Figures 2020 [Internet]. 2020 [cited 2021 May 1]. Available from: l-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf
2. Noone AM, Howlader N, Krapcho M, et al. SEER Cancer Statistics Review (CSR) 1975-2015 [Internet]. 2018 [cited 2021 May 1]. Available from:
3. Letourneau JM, Ebbel EE, Katz PP, et al. Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer. Cancer [Internet]. 2012 Apr;118(7):1933–9. Available from:
4. Molina JR, Barton DL, Loprinzi CL. Chemotherapy-induced ovarian failure: manifestations and management. Drug Saf [Internet]. 2005;28(5):401–16. Available from:
5. Ghaemi SZ, Keshavarz Z, Tahmasebi S, Akrami M, Heydari ST. Conflicts women with breast cancer face with: A qualitative study. J Family Med and Prim Care [Internet]. 2019 Jan;8(1):27–36. Available from:
6. Anazodo A, et al. How can we improve oncofertility care for patients? A systematic scoping review of current international practice and models of care. Hum Reprod. 2019 Mar;25(2):159–79.
7. Ghorbani B, Madahi P, Shirazi E, Ardekani HS, Kamali K. Iranian Oncologists’ Attitude towards Fertility Preservation in a Sample Group. J Reprod Infertil [Internet]. 2011 Jan;12(1):33–6. Available from:
8. Johnson RH, Kroon L. Optimizing fertility preservation practices for adolescent and young adult cancer patients. J Natl Compr [Internet]. 2013 Jan;11(1):71–7. Available from:
9. Brink HV, Chizen D, Hale G, Baerwald A. Age-related changes in major ovarian follicular wave dynamics during the human menstrual cycle. Menopause [Internet]. 2013 Dec;20(12):1243–54. Available from:
10. Kim JH, Kim SK, Lee HJ, Lee JR, Jee BC, Suk CS, et al. Efficacy of random-start controlled ovarian stimulation in cancer patients. J Korean Med Sci [Internet]. 2015 Mar;30(3):290–5. Available from:
11. Coyne K, Purdy M, O’Leary K, Yaklic JL, Lindheim SR, Appiah LA. Challenges and Considerations in Optimizing Ovarian Stimulation Protocols in Oncofertility Patients. Front Public Health [Internet]. 2014; Available from:
12. Nouri K, Tempfer CB, Lenart C, Windischbauer L, Walch K, Promberger R, et al. Predictive factors for recovery time in patients suffering from severe OHSS. Reprod Biol E [Internet]. 2014 Jul;12(59). Available from:
13. Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Ster [Internet]. 2008 Jan;89(1):84–91. Available from:
14. Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C. Comparison of “triggers” using leuprolide acetate alone or in combination with low-dose human chorionic gonadotropin. Fertil Steril [Internet]. 2011 Jun;95(8):2715–7. Available from:
15. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, The Practice Committee of the American Society for Reproductive Medicine. Female Age-Related Fertility Decline. ACOG Comm Opin Num 589. March 2014 Reaffirmed 2020;1–3.
16. Mantovani A. Molecular Pathways Linking Inflammation and Cancer. Curr Mol Med [Internet]. 2010;10(4):369–73. Available from:
17. Vannuccini S, Clifton VL, Fraser IS, Taylor HS, Critchley H, Giudice LC. Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update [Internet]. 2015 Sep;22(1):104–15. Available from: